and malignant melanoma. In the majority of breast cancer cases, too, the first metastases are found in the lymph nodes, specifically in the axillary lymph nodes. Symptoms and diagnosis Lymph node metastases are usually painless. This contrasts with lymphadenitis (inflammation of the lymph nodes, such as due to a viral infection), in which the lymph nodes are both enlarged and painful when pressed on. Enlarged lymph nodes can be identified by palpation (pressing on the spots to feel lumps under the skin). Sonography (ultrasound) can be used as a further diagnostic method. In some cases, lymph node metastases are the first symptom of cancer. Treatment The treatment of the lymph node metastases is usually part of the treatment of the primary tumor. If the primary tumor is operable, all lymph nodes located in the lymphatic drainage area of the diseased organ are often removed. This procedure is called a lymphadenectomy (lymph node removal). With sentinel lymph nodes, a different concept is used in some cancers, specifically breast cancer and prostate cancer . The sentinel lymph node is the first lymph node in the drainage area of the tumor lymph. If this is not affected, the more distant lymph nodes are very likely tumor-free and do not have to be removed. The need to remove lymph node metastases is a controversial topic. References Cancer